July 2015

Jul 20, 2015

The focus in the future is on keeping you well rather than just treating you when you are sick. Cone Health has been an early leader in this transformation and we believe the communities we serve are reaping the benefits. If the trend holds, this is a story of national consequence.

Terry Akin is careful to avoid overstating the case based on limited evidence to date, but he makes it clear that early returns from the Triad HealthCare Network ACO are encouraging in terms of the most important metrics -- patient outcomes and community health -- as well as the non-trivial matters of cost and efficiency.

Accountable Care Organizations may draw political fire because of their association with Obamacare, but as a general approach they are no more controversial than the proposition that an ounce of prevention is worth a pound of cure. That's why stuff like readmission rates and chronic-care management matters so much. If this can be done at scale and sustained over time, it will be a very big deal.

Jun 27, 2015

I wrote a lot of newspaper columns over the years. Some have aged better than others.

Kind of proud to have published this one in my hometown newspaper way back in 2003: "People who don't approve of gay marriages shouldn't have them."

Before I dislocate a shoulder patting myself on the back, let me be clear that any ahead-of-the-curveness on my part was rooted in the courage of friends, family members, and many others who lived their lives fully and openly at a time when it was much harder to do so.

Apr 13, 2015

If you were to argue that transience is Greensboro’s most enduring trait I would concede that you had a defensible position. Moving on is as much an American habit as overuse of the past tense is a Southern one, and we live them both. The general from whom we borrowed our name was just passing through on a business trip and favorite son O. Henry, like other celebrated natives in his wake, got out as soon as he could. Our best-known nickname, the Gate City, advertised a rail junction as the “gateway to the South”; thanks for coming, bye-bye. The same value proposition lay behind the huge Overseas Replacement Depot during World War II and the construction of the interstates and an air-freight hub. We brag about our GPS coordinates in terms of proximity to the mountains and the beach, and even the geological designation of piedmont is defined by the region next door.

Feb 03, 2015

Was the 1979 Klan/Nazi-CWP shootout a massacre?

Sure it was, by some formal and vernacular definitions.

I have used the word "massacre" to describe the event, and although I didn't remember doing so I've been informed by Google that I called it "the Greensboro Massacre" on at least one occasion (before the T&R thing got going, but after I'd changed my own POV on the topic).

But Allen Johnson is right about "the power of words to shape how we view an event," and that has to influence the choice of words on the proposed historical marker.

"Massacre" in this context is more than a vocabulary word. It's a political term that tends to mean "the killing of a lot of good guys by bad guys who suffer far fewer losses." (And, yes, it can be a massacre even if the alleged good guys are armed).

So the problem here is that a lot of people are reluctant to implicitly define the CWP as good guys, even though most agree that the other side was bad.

I'd be OK with "The Greensboro Massacre" if the text that followed was not going to be some Tweet-length summary that couldn't possibly capture the facts about the day and all the players (including the role of law enforcement, which gets left out of the story way too often).

So I'd go with "The Greensboro Shootout."

Elsewhere, Lex makes a good point about Mike Barber "ridiculing and diminishing the tragedies in the lives of others." I doubt that was Barber's intent, but it plays that way, so maybe he can broaden his thinking a bit.

You look out the window and in front of you a chaotic scene of attack, retreat, gunfire, and death plays out in your neighborhood. You scream for your daughter to get down and take cover. Later, you comfort her but the color of the day, week, and who knows how much more has darkened. She's seen things you never wanted her to see. You feel a sense of failure and guilt over not being able to protect her. Something valuable was lost.

I know a lot of you find this whole slow and sometimes retrograde journey dispiriting. I don't. There has been genuine movement toward wider understanding and even reconciliation over the years. The long arc is bending in the right direction, and the marker -- should it ever go up -- is part of that process.

Nov 20, 2014

This press releasenews article about ArtsGreensboro comes complete with info on how to support the group's fundraising campaign, but doesn't mention the N&R's pay-for-play deal with AG, as promised for bought stories.

So are we to assume that this particular gusher is just straight news?

It doesn't really matter, since you can't read it without wondering how the business relationship influences coverage, and concluding that there's really no difference at this point between one type of story and the other.

Will other non-profits get this kind of coverage when they launch campaigns?

FWIW, I couldn't be happier about all the good news reported in the piece.

Sep 29, 2014

A large and positive decision at this weekend's Cone Health leadership retreat to move ahead with a new Women's Hospital on the MoCo campus, and to remake our behavioral health program as well. Details here.

This is an opportunity to take the much-loved program at the current WH and create something even better, making GSO a center for women's health.

Sep 17, 2014

Kay Hagan should hold a press conference outside of MoCoHo and demand to know what Thom Tillis means when he talks about repealing Obamacare.

Does he want to go back to screening out people with pre-existing conditions?

Kick young adults off family policies?

Uninsure the millions who have gained coverage?

Undo the success of the ACO program, which is making a big difference here in GSO?

If not, what's his plan for keeping the stuff people like, and paying for it?

Not that Tillis talks much about ACA anymore. After months of positive news, he can't afford to be pinned down on what his alleged repeal plan would really mean. You have to dig at his campaign site for Obamacare bashing.

But Kay's site also avoids the issue. She's running a three-yards-and-a-cloud-of-dust campaign and is afraid that the law's lingering stigma will hurt her.

Which it will, if she and/or Democratic supporters don't get the message out.

Triad HealthCare Network, the Accountable Care Organization created by Cone Health and local physicians, is getting great results.

According to numbers released yesterday by the Centers for Medicare and Medicaid Services, THN is a top ten performer nationally in terms of money saved and shared savings returned.

This is a big deal.

ACOs are a key part of the Affordable Care Act, aka Obamacare. They are intended to save money and improve care by coordinating efforts between different parts of the healthcare system. For example, instead of waiting for a diabetes-related problem to send someone to the emergency room, doctors and nurses use monitoring and outpatient services to keep the person healthier on an ongoing basis. This kind of medicine ends up being cheaper and more effective.

After certain thresholds are met, the savings are split between Medicare and the ACO.

THN met its marks for quality, and saved $21.51 million, of which it gets back $10.54 million. This is good for patients, for our local health system, and for the Medicare budget.

It's not easy work, and most ACOs did not qualify for money back in the latest period. It could take years for this to really pay off at the national level, at least in comparison with total Medicare spending. Credit THN and Cone leadership for recognizing the value of this program early, and executing well.

Sep 12, 2014

If you had asked me to name the wealthiest town in North Carolina, I would not have guessed that the correct answer (according to this) is Marvin.

More here and here. Looks like a lot of well-off people moved in pretty recently.

They say this like it's a good thing: "Residents benefit from low Union County taxes while still enjoying all the conveniences of prime shopping, dining & entertainment at Blakeney, Stonecrest & Ballantyne Village."

Sep 07, 2014

Sep 05, 2014

The News & Record’s policy is to screen and edit letters for factual errors. Occasionally not all inaccuracies are caught.

I was hoping for a little more detail on process, and perhaps a bit more acknowledgement of the scale of the problem.

Below, the letter as published in this morning's print and online editions:

Expressing an opinion is a right. Having an opinion published in the newspaper is not a right.

The News & Record should not publish letters that contain clear misstatements of fact without appending clarifications or corrections.

One recent letter to the editor said Women’s Hospital might close in October. This is not true. Women’s Hospital might close in 2019. Saying otherwise is not an opinion, it’s a mistake. It is reckless for the N&R to publish that kind of misinformation without telling a concerned community the real story.

An even more recent letter stated that scientists now have evidence that dinosaurs lived several thousand years ago. This is not true. Saying otherwise is not the writer’s sentiment, it’s an assertion of (alleged) fact that should not be printed without commentary in a serious newspaper.

We are entitled to our own opinions but not our own facts. What is the newspaper’s policy on the accuracy of information it publishes?

Aug 25, 2014

People are talking about the N&R opinion page. They are not saying good things. On Facebook, the paper's former top editor (and before that, opinion editor) mocks his old employer's standards for LTE. There's a pile-on in the comments. [John Robinson, via FB, re his comment ("Next up, a letter explaining that ghosts are scientific fact"): "I don't mock the paper's standards. I do question them in that case. That's different than mocking them."]

Another former editor posts at his blog under the headline, "Letters to the editor: Now the News & Record is just trolling us." That's preferable to the theory I floated a couple of weeks ago: They just don't care.

Oddly silent are the folks on Market Street. Sure, their actions speak volumes: The N&R will publish letters containing factual errors obvious to a clever ten-year-old. It's policy. But why?

Maybe their take on free speech enshrines a right to spew misinformation in a newspaper, because, Opinion! Maybe they don't have enough people left to monitor letters for content, or enough readers left to fill the page with non-fiction. We don't know.

There's a conversation out here among their readers, but the editors are not participating. It's a pre-internet approach to journalism.

I guess we could write a letter to the editor.

Seriously, my draft is below. If you want to sign it, leave your real name in the comments.

To the editors:

Expressing an opinion is a right. Having an opinion published in the newspaper is not a right. The News & Record should not publish letters that contain clear misstatements of fact.

One recent letter to the editor said Women's Hospital might close in October. This is not true. Women's Hospital might close in 2019. Saying otherwise is not an opinion, it's a fallacy. It is reckless for the N&R to publish that kind of misinformation.

An even more recent letter stated that scientists now have evidence that dinosaurs lived several thousand years ago. This is not true. It should not be printed without commentary in a serious newspaper.

Maybe the editors can explain their policy and the reasons for it in a note or editorial.

Aug 19, 2014

From the advertiser’s point of view, the nation’s newspapers have become little more than a blue-bag delivery service, with a horoscope and enough local sports inside to get people to open the bag.

Inserts are one of the last sources of advertising to resist digitization. They are also the next to go.

To follow on my latest post about the dismal direction of the N&R, it bears saying -- again -- that these folks are dealing with real problems. Like, existential problems. The inclination to protect the insert revenue is understandable, but the new paywall strategy is a false move.

I don't claim to know the right way to save the local news-org business, but I'm pretty sure it involves a serious commitment to high-quality local reporting and digital delivery -- two things the Market St. managers and their absentee bosses abjure.

But, yeah, this is horrifying:

I disagree with Shirky on one key point. When he says, "The closing of a local newspaper matters more than the closing of a local shoe store for only one reason — newspapers employ journalists," he understates the value of a newsaper as town square and public advocate. Maybe that's what he means to say, and maybe he thinks journalists will fulfill those functions elsewhere, but if so, where?

Aug 16, 2014

I've pretty much given up on asking the N&R to vet LTE for basic accuracy before printing them. Roch still tries, but after all these years the message from Market Street is clear: We don't care.

Today's example gets my attention because it's about a story in which I have some personal involvement: the possible relocation of Women's Hospital to the Moses Cone campus. This is and should be a topic of community discussion, and the daily paper is an important part of that discussion. Too bad its contribution this morning is to sow fear and confusion by publishing without comment a bit of serious misinformation.

"I’m due to have my baby in October of this year and was saddened to hear that the only facility in Greensboro for women may be closing a few weeks before I deliver," writes Kendra Turner of McLeansville.

That would be harsh. But the possible move would not happen until 2019.

Part of the problem may lie with the News & Record article Ms. Turner relied upon, which omitted the essential fact. Still, you'd think a newspaper editor would be able to glean from the story that any possible closure is far from imminent. But that would require an editor to think about the letter before publishing it.

My resignation about the LTE is part of larger rethinking of my expectations from the N&R. There is no evident plan to rebuild it into one of the best newspapers in the south, as it once was, much less a leader in digital media. Its aspirations appear to be small-time and small-town. Good work still appears with some frequency, but that does not seem to be management's goal.

So it feels futile to complain at this point about yet another day of front-paging a boosterish take on the local PGA tour event [post updated with Sunday A1 -- again with the golf] instead of, say, doing some reporting on what the huge national story about militarizing the police means in GSO. The news hole is up for sale, and the opinion section is on autopilot. It is what it is. Move on.

Aug 03, 2014

[T]he building aesthetics on the plans unfortunately reflect the specialties of the architect chosen for the project, whose portfolio is mostly composed of generic suburban motels and fast-food restaurants.

This is important stuff. Downtown GSO has been creeping ahead for decades. Now it’s on the cusp of the most significant building boom in my lifetime. We’re about five minutes away from being recognized for an urban renaissance.

It’s an excellent time not to screw things up.

We need a walkable city that works at human scale. The slow fuse has allowed a lot of primo streetscape to survive, but precedent is not wholly encouraging. Or, as Dave puts it, “Will Bellemeade Village Be An Urban Village Or A Suburban Development That Happens To Be Downtown?”

Carroll’s conciliatory remarks about Lindsay St., as appended to the N&R version of Wharton’s article, are good news. Let’s hope he follows through, and that a similar spirit animates the design of the big projects still to come. Our music hall should be welcoming even for people who never go inside (left, Luna just chilling at Lincoln Center). And it's going to take some vision to, say, integrate the Union Square campus into the street life of South Elm Street.

The City has to hang tough on design issues. Downtown’s success has a lot of drivers and a lot of stakeholders, but ultimately it is our public space, and that is a valid public concern.

Jul 26, 2014

Consumers don’t give a sh** why you’re pricing your digital subscription at whatever level it’s priced, they only care that the product is worth the price.

The N&R's new absentee owners have made it clear that their first priority is defending print circulation. JR and Jon Lowder ask some good questions about the wisdom of the new paywall plan.

The emphasis on paper is nothing new. The previous absentee owners brought in a circulation guy as publisher. That did not go well, online or off. Print continued to dwindle, and a decade after its brief moment of online glory the N&R does not have a good digital product or a strong digital brand. Management seems content to let whatever buzz builds around their stories happen on Facebook or other sites. Innovative ways of info-sharing and audience building are MIA.

We all understand the math that makes the vanishing print business desirable, and it's easy to say that nobody has cracked the reinvention code yet, so experiments are the only way to go. But why is the rear-guard strategy going to work in 2014 when it didn't work before?

And what comes next? Will BuffettCo invest the (hoped-for) print-circ dollars in more reporters to guard and grow its local news and info franchise? Will it use the (possible) revenue to hire editors who really understand digital media?

Jul 16, 2014

Does yesterday's rout of Berger Jr. show weakness in the local and state GOP establishment, or was it more a reflection on a candidate who grew less attractive to voters the better they got to know him?

Surely a 17% drop in votes between primary and run-off bespeaks a certain lack of passion for the man.

Walker ran an impressive grassroots campaign and deserves all credit for that. And some prominent local Republican officials were Walkerites, so the establishment wasn't monolithic in any case.

Maybe it was just hubris by the machine to try promoting Berger Jr. so rapidly in the family business. Will that have lasting consequences?

The next test for the establishment will be its ability to rally behind the man they trashed so energetically for the past couple of months.

Given Berger Jr.'s association with the GOP powers-that-be in Raleigh, what if anything does this portend for Thom Tillis?

May my prediction below about November prove as accurate as the rest of the piece.

/update

Over at the Style and Cut shop last week an old-school local conservative told me that he plans to vote for Mark Walker instead of Phil Berger Jr. because Berger Jr. is the machine's man and Walker just seems like, well, a better guy.

Not the first time I heard that as the race for the 6th district GOP nomination came down to the wire. Will those things be enough to win the race for Walker? I doubt it. My bet is that Berger Jr. wins tomorrow and goes on to win in November, even if some Walker voters hold a grudge against him. The 6th is just drawn that way -- the party-registration balance has shifted with its new borders, but that didn't slow Howard Coble down in 2012.

There's not much daylight between the two Republicans on the issues (I disagree with both of them strongly and often) so the barbershop logic could create an upset. Even those factors, though, won't necessarily break the insurgent's way.

Walker's anti-establishment vibe taps into the energy that helps propel the Tea Party movement and he appears to have the grassroots momentum, but Berger Jr. has the money and (presumably) GOTV machinery. Berger Jr.'s endorsement from the Beloved Incumbent is offset by Walker's blessing from BJ Barnes. I'd guess the insider/outsider game is a wash.

(Speaking of endorsements, I don't know how seriously John Hammer takes his theory about the N&R's 3-D chess game, but here outside the bubble the stuff Roy Carroll pays to publish sounds...weird.)

Personality can be a wild-card in politics, and the impact is hard to predict. Berger Jr. is not cuddly and his allies even less so, but maybe that's already baked into his profile. Walker has skated on some bad judgement because he's Not A PoliticianTM but if voters think he's down in the mud with Berger Jr., that's trouble.

When your argument is about massiveness of scale, just six months in, it may be time to change the subject. Hey, look at those kids crossing the border!

If the Hagan campaign won't do it, outside funders need to start running ads right now that discuss the success of this law -- in numbers, and in human terms -- and the impact of Tillis-led Medicaid stonewalling.

Jun 27, 2014

A few years back a local arts exec was wondering aloud what could be done about the News & Record's dwindling coverage of GSO culture.

The obvious answer: Roll your own.

Things were only going to get worse on Market Street, and while creating a meaningful online arts presence would take some work, new media is better than no media.

Flash forward to this week and we see ArtsGreensboro finally taking some ownership of its media needs by raising money and...giving it to the News & Record.

For a reported $15K, the paper will write 70 stories about the local arts scene over the course of a year, in addition to its regular arts coverage.

This unusual pay-for-play arrangement has drawn attention from national press-watchers and outrage from a local competitor. A concerned citizen interrupted my dog-walk yesterday to ask me about it. People want to know how the N&R reviews and profiles can escape the realm of advertorial happy talk, and if a critical eye can still be directed at the arts institutions themselves, and what other parts of the news hole might be up for sale. Good questions, all.

But let's also look at the value proposition for the arts community. Assuming all purchased articles are, as promised, additive to arts coverage the N&R would do anyway, that's about six new articles per month. Depending on the length, placement, and quality of these pieces, that could be a pretty strong bump in arts coverage.

I'm not convinced, though, that it's the best investment for ArtsGreensboro. My guess is there's a lot of overlap between the existing audience for arts institutions and the readership of the print newspaper and its stunted online presence (which raises more questions: Will the paid-for articles be available online? Promoted via Facebook? Etc.). That doesn't mean the articles will be without impact, but it probably limits their contributions to outreach and brand-building.

What if that $15K was being spent instead on digital media that cut out the middleman? The N&R rate comes to $214 per article, which, sadly, will buy a lot of freelance work in this town, especially for things like reviews. Assume some costs for design, hosting, and management, and you've still got plenty of money for content that is shared via channels that people under the age of, well, me, actually use, and that potential visitors to the area can find easily.

Meeting the needs of smartphone nation seems preferable to purchasing space in a shriveling organ read largely by the people who already know what you're doing -- especially when the purchase itself diminishes the credibility of the paper. And since the arts articles are subsidized by donations, the digital strategy would not be constrained by the same economics that make online publishing so tough.

Back when I had that conversation with the arts exec, this stuff was still new enough that wishing for the old days was sort of understandable. And that mindset wasn't limited to GSO -- at about the same time I did a consulting gig for a PR shop that wanted more coverage in the New York Times for its museum clients, and their response to my roll-your-own rah rah was similarly unexcited.

But that was then, and this is now. It's past time for fresh thinking. Paying off the local daily is a new approach, but it's not the long-term solution to the probelm of anemic arts coverage.

Jun 23, 2014

In 2007 I finally got around to reading The Quiet American and then devoted a newspaper column to the similarities between Graham Greene's prescient view of Vietnam and our then-ongoing misadventures in Iraq.

Now we're up to the part of the story where Fowler, the jaded Brit, sees the next disaster coming:

"We go and invade the country; the local tribes support us: we are victorious: but like you Americans we weren't colonialists in those days. Oh no, we made peace with the king and we handed him back his province and left our allies to be crucified and sawn in two...We shall do the same thing here. Encourage them and leave them with a little equipment...

So, obviously this map of the "most liberal and most conservative towns In each state" is click-bait and includes odd methodological choices like comparing major cities and small towns, but, still, beyond the fact that any North Carolinian is bound to say, "really? Not Chapel Hill?", I think they probably got it close to right on dear old GSO.

Jun 16, 2014

In contrast to today, Americans in the Gilded Age openly recognized the connection between monopoly power and inequality. They enacted the Sherman Antitrust Act in 1890, and the Clayton Antitrust Act and the Federal Trade Commission Act in 1914, to safeguard themselves from concentrated economic power, which they believed posed a threat akin to political autocracy.

Political power is not the only power to be feared, and sometimes it's a necessary bulwark against corporate power. This is a deeply American idea --Jefferson understood it -- from which we've veered in a radical direction.

Another angle, this one with a surprising local connection: "The decisions culminate a thirty-year trend during which the judiciary, including initially some prominent liberal jurists, has moved to eliminate courts as a means for ordinary Americans to uphold their rights against companies."

[L]egislators in North Carolina — whose $86 billion public pension fund is the 7th largest in America – are proposing to statutorily bar the public from seeing details of the state’s Wall Street transactions for at least a decade. That time frame is significant: according to experts, it would conceal the terms of the investment agreements for longer than the statute of limitations of various securities laws.

Jun 09, 2014

Your state’s decision not to expand health coverage is creating two Americas: one where millions are benefiting from preventive care and covered treatments while local economies get stronger and healthier by the day; and another where patients continue to show up to emergency rooms without a way to pay and the local economies are falling further and further behind.

Kay Hagan signs a letter to governors, including our own, from states that have not accepted Medicaid expansion.

The letter is about Medicaid, but refers directly to the ACA. Hagan needs to hammer home the message that burgeoning healthcare coverage = ACA = Obamacare = no exclusion for pre-existing conditions etc.

And she should emphasize the importance of personal stories and personal responsibility. As long as people are going to get healthcare in some way -- and they are, and they should -- they should have some way of paying for it.

Related: "Ms. Marks had a hole in her tooth this winter, she said, and went to the emergency room. They gave her a painkiller and a bill for $600, which she has ignored. The tooth remains so damaged that she can chew on only one side of her mouth."

Our system -- and those of us with private insurance -- are paying for this kind of inadequate care already. Rationalizing payment and delivery is the smart and humane way to go.

Jun 04, 2014

Councilman Tony Wilkins wants the city to consider creating a year-round International Restaurant Row to promote existing and future restaurants on High Point Road in Greensboro.

Makes sense to me to recognize and support one of the good things already happening in GSO, improve our brand in the process.

Best to do it in a way that addresses concerns raised by Luck Davidson in the article, and is respectful of work already underway on this front and mindful of business owners in other parts of the city.

Annie Penn Hospital president Mickey Foster and vp of nursing & patient services Debbie Green gave a presentation at this huge Cleveland Clinic conference on the topic of "99th Percentile in Employee Engagement and Its Impact on Clinical Quality."

If I worked in the local paid media I'd think about using that national recognition to set up a story about the Reidsville hospital and the good things happening there.